Medical Toxicology Program, Department of Emergency Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
J Med Toxicol. 2012 Mar;8(1):10-4. doi: 10.1007/s13181-011-0187-x.
Intravenous lipid emulsion (ILE) is an emerging therapy for refractory cardiotoxicity due to lipid-soluble drugs. The purpose of this study was to assess survival to hospital discharge, effects on hemodynamic parameters, and adverse event occurrence for patients who were treated with ILE as part of the resuscitative effort for drug-induced cardiotoxicity. This is a multicenter retrospective chart review of inpatients at three tertiary referral medical centers receiving ILE for drug-induced cardiotoxicity between November 2007 and March 2009. Nine cases with drug-induced cardiovascular collapse, defined as cardiac arrest or refractory shock, were selected for review if patients received either bolus or infusion of ILE in any combination. No interventions were done. The main outcome measures were survival to hospital discharge, effect on hemodynamic parameters, and adverse event. Hemodynamic vital signs (heart rate, systolic blood pressure, diastolic blood pressure, calculated mean arterial pressure [MAP]) were measured before administration of ILE and up to five measurements (if available) were recorded after administration of ILE. Attribution of adverse events was determined by assignment of Naranjo adverse drug reaction (ADR) likelihood score (3) with adjudication of three medical toxicologists; disagreements were settled by majority consensus. Of nine cases identified based on inclusion criteria (three cardiac arrest, six refractory shock), five (55%) survived to hospital discharge. ILE regimens were bolus alone in five patients and bolus plus infusion in four patients. Hemodynamic trends in response to ILE demonstrated no difference in MAP immediately pre- and post-administration of ILE (p = NS). Administration of infusion (versus boluses alone) did not demonstrate a statistically significant improvement in MAP. Adverse events due to ILE therapy that were categorized as "possible" or "probable" based on Naranjo scores included lipemia, digit amputation, lung injury, renal failure, and deep venous thrombosis. ILE administered to patients with drug-induced cardiovascular collapse was associated with 55% survival but with clinically significant adverse effects. At this time, ILE should be restricted to cardiotoxicity involving cardiac arrest or refractory shock until further prospective studies can better evaluate risks and benefits of ILE therapy.
静脉内脂肪乳剂（ILE）是一种新兴的治疗方法，用于治疗脂溶性药物引起的难治性心脏毒性。本研究的目的是评估接受 ILE 治疗的患者的住院存活率、对血流动力学参数的影响以及不良反应的发生情况，这些患者是作为药物引起的心脏毒性复苏努力的一部分接受 ILE 治疗的。这是一项多中心回顾性病历研究，纳入了 2007 年 11 月至 2009 年 3 月期间在 3 家三级转诊医疗中心接受 ILE 治疗的药物引起的心脏毒性住院患者。如果患者接受了 ILE 静脉推注或静脉滴注，或者联合应用了 ILE，则选择了 9 例药物引起的心血管衰竭（定义为心搏骤停或难治性休克）的病例进行回顾性分析。未进行任何干预。主要观察指标为住院存活率、对血流动力学参数的影响和不良反应。在给予 ILE 之前测量血流动力学生命体征（心率、收缩压、舒张压、计算的平均动脉压[MAP]），并在给予 ILE 后记录多达 5 次测量值（如果有）。不良反应的归因通过分配 Naranjo 药物不良反应（ADR）可能性评分（3 分）并由 3 名毒理学家进行裁决来确定；意见分歧通过多数共识解决。根据纳入标准确定了 9 例病例（3 例心搏骤停，6 例难治性休克），5 例（55%）存活至出院。ILE 方案为 5 例患者单独静脉推注，4 例患者静脉推注联合静脉滴注。ILE 治疗反应的血流动力学趋势显示，在给予 ILE 前后 MAP 无差异（p = NS）。与单独静脉推注相比，静脉滴注并不能显著改善 MAP。基于 Naranjo 评分，将 ILE 治疗相关的不良反应归类为“可能”或“很可能”，包括脂血症、指端截断、肺损伤、肾衰竭和深静脉血栓形成。在药物引起的心血管衰竭患者中给予 ILE 与 55%的存活率相关，但存在明显的临床不良反应。目前，ILE 应仅限于涉及心搏骤停或难治性休克的心脏毒性，直到进一步的前瞻性研究能够更好地评估 ILE 治疗的风险和益处。
